The Healthcare and Enterprise Wireless Experience : August 2019

Bluetooth and Direction Finding Location

Integra Systems, Inc. has been working for several years on many projects using our recommended SOC being Nordic.

Nordic is the market leader in Bluetooth Low Energy connectivity, with a growing portfolio of wireless devices, LTE-M and NB-IoT being the latest augmentation.

Bluetooth direction finding is the major feature of the Bluetooth 5.1 Core Specification.

It is designed to enhance location services where previously only signal strength based technology has been used with Received Signal Strength Indication (RSSI).

Bluetooth direction finding will offer a new and improved use case for Real Time Location Systems (RTLS) for asset tracking in a wide range of scenarios from logistics and warehousing to value asset security in hospitals and factories.

It also brings added user experiences in proximity-based scenarios for consumer awareness and contextual information.

Bluetooth direction finding can be used to detect location in either 2D or 3D dependent on the complexity of its implementation.

Angle of Arrival (AoA) and Angle of Departure (AoD)
Bluetooth direction finding is based around the two key concepts of Angle of Arrival (AoA) and Angle of Departure (AoD).

This makes use of the angular phase-shifts that occur between antennas as they receive (AoA) or transmit (AoD) RF signals.

With the use of antenna arrays at either side of the communication link phase shift data can be determined and from this, location can be calculated.

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Medical Wearable Devices - The Market

Medical wearable devices are trying to find their niche for patient monitoring of physiological parameters in and outside of the hospital. The technology advanced cost curve is allowing this.

There is a lot of competition and investment it seems in this space. This has been going on for a number of years as the convergence of Bluetooth(r), the Smart Phone, and all kinds of applications are being developed for mobile devices for healthcare connectivity. This has allowed new companies to enter into the medical wearable space based upon this new technology and enterprise use model.

While all of this may seem new; it follows the use model of medical telemetry in the clinical space that actually got it's start in 1958 as a part of the space program. However, medical telemetry was only inside the walls of the hospital. The author has been around this space since 1983 as well provided expertise crossing all ares of medical device connectivity.

Product Design: It is often in product development the human component could be overlooked. How will the patient and/or clinician manage the wearable device and set up all the physiological parameters? Management includes the battery life and charging, the training of the clinician and patient care model, and finally the incorporation of the technology into their enterprise in a secure way.

Clinicians went to school to take care of patients...not technology.

Another area to look at is compliance. How do you know that patients outside of the hospital setting will actually use the technology? If outside of an acute care setting how will this data get to the right person? Is the data relevant and of quality for a physician to make a clinical decision on? The standard best of practice for a initial cardiac assessment is still a 12 lead EKG analysis with full interpretation.

From an executive corporate standpoint, how will the technology fit the overall business model with the correct ROI? Is the technology providing relevant and actionable data? Who owns the data and how will costs be reimbursed?

These are just some things to think about.

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Proprietary versus Standards Based Wireless 2019

Over the past twenty years in the medical device community and within the healthcare enterprise there has been this debate about proprietary versus standards based wireless offerings. It started out when the Wireless Medical Telemetry Service was introduced in the late 1990's and then 802.11b being approved in 1999. The start of the Wi-Fi revolution as we know it.

The author provided OEM guidance on the first medical telemetry system using 802.11 FHSS around 1999. This was ahead of it' time but followed the logical next steps in the WLAN revolution which kicked off with the Wi-Fi Alliance forming in 2000.

Then came the whole era of smart pumps incorporating 802.11 advances from the early 2000's to another medical telemetry company architecting 802.11 as a part of their enterprise solution.

Just like Wi-Fi, Bluetooth has provided a standards based approach and is enjoyed by a surrounding community of interoperability and product roll-outs in multiple vertical markets. Millions of $ of investment in R&D has driven innovation and security advances.

The introduction of the smart phone incorporating BTLE pretty much has solidified BTLE as the standards based personal area network of choice.

Most recently several medical device companies have incorporated BTLE into their solutions to also include an implantable device. This is huge as it overcomes that argument that Wi-Fi and or BTLE is not safe, reliable, or secure. The implantable device company followed all NIST guidelines. https://www.nist.gov/topics/cryptography

We additionally see the whole proprietary real time location system model becoming legacy as BTLE 5.1 provides the granularity of accuracy. Also BTLE is fast becoming incorporated in WLAN enterprise AP(s) to include mesh capabilities

Bottom line, while proprietary wireless technology may have had it's place in healthcare; standards based architecture always wins out. It wins out because of the ground swell of investment, standards, interoperability, security, and wide spread adoption driving down cost.